Consultation with the specialist. Chest pain in children.

Chest pain is a common complaint among children of all ages. It rarely is due to cardiac disease, but deserves careful evaluation for this possibility, with laboratory tests performed in limited cases. The child who has pain of acute onset that interferes with sleep, is precipitated by exercise, or is associated with dizziness, palpitations, syncope, or shortness of breath should be evaluated with the aid of laboratory tests. This includes at least a chest radiograph and electrocardiogram. Also, pain in the child who has a history of coin ingestion, trauma, previous cardiac disease, or conditions that put him or her at risk for developing cardiac pathology deserve further study. Likewise, those who have a history of conditions such as asthma, Marfan syndrome, or sickle cell disease warrant special consideration. Finally, most of those who have an abnormal physical examination (fever, respiratory distress, abnormal breath sounds, cardiac murmur, abnormal rhythm or heart sounds, palpable subcutaneous air, or obvious trauma) also require a chest radiograph and an electrocardiogram. However, the child who has chronic chest pain normal physical examination with no worrisome history needs reassurance and careful follow-up rather than extensive studies.